GOA THIRD PARTY CENTER

IMPORTANT INFORMATION REGARDING PALMETTO'S NEW FILING REQUIREMENTS FOR POST-OP CARE

GOA Members,

We have received more detailed information regarding Palmetto's new filing requirements for post-op care. Dr. Paul Batson, VisionAmerica, wrote an article outlining the specific information and action items. We will continue to update you as we receive new information.

Why Am I Not Getting Paid for My Cataract Post-Ops?

By Dr. Paul Batson

I have talked with several doctors over the past few weeks and we've had a lot of calls from billing staff regarding denials for post-op care of cataract patients.

With the Palmetto conversion, there are definitely some changes in billing requirements that need to be considered. As such, if you have not paid much attention to your Medicare patients cataract post-op reimbursement lately, you may want to take a look!

Here are a few quick reminders of things that may be leading to denials.

Using the standard CMS-1500 claim fields:

1. Field 24A (Date of Service) should be the actual date of surgery - not when you see the patient

2. Field 24G (Days or Units) should be the number of days that you are responsible for the care of the patient. Examples:

a. The patient returns to you for the one-day post-op visit and all subsequent care then Field 24G will be "90"

b. The patient is seen by the surgeon for the one day and one-week post-op and then returned to your care (i.e. you are assuming care of the patient on day 8) then Field 24G will be "83".

3. If your system will not support that number of units, you can also use Field 19 (Additional Claims Information) and must state "Care assumed from Dr. X (insert surgeon name); (Date assumed)"

4. Field 24B (Place of Service) - there is still some confusion regarding this field. After several discussions with Palmetto, this is our best understanding.

a. If you are providing the entire post-op care (90 days) then your place of service can be the normal "11" for office.

b. If you are splitting the post-op care with the surgeon then the place of service needs to match the original place of service in which the surgery was performed.

i. Ambulatory Surgical Center would be 24

ii. Hospital Outpatient Surgery would be 22

I hope the above provides a little more clarification. You can find the original Palmetto notice here .

I would also mention that even in the best case scenario, you will still find that you will receive a denial and a request for medical records. We have find the easiest way to provide this documentation is through their online portal. If you've not registered or are familiar with it, you can find that portal here